090131_INSPECTIONS_20171231

.5006- � r
►j
(Type of Visit: �Kompliance Inspection O Operation Review (OStructure Evaluation O Technical Assistance
Reason for Visit: 0 Routine omplain 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: — / Arrival Time: ,'. (� I Departure Time: ' 3 County: �.7r ,4.c_ Region:
Farm Name: Gr Et'-r is Owner Email:
Owner Name: v` � d y1 Phone:
Mailing Address:
Physical Address:
Facility Contact: /� Q �f�t_ Title: ©[�'j'I�*'� Phone:
Onsite Representative: integrator: f r
.01
Certified Operator: Certification Number: /Dp 3 3p2_g1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design CurrentRiDesign
Swine Capacity° Pop. Whet Poultry Capacity Pop
Cat#le
Current
Capacity Pop.
Wean to Finish
Wean to Feeder p o
Feeder to Finish
La er
—
Dairy Cow
Nan -La er
Dairy Calf
Yr
F
urrent
D , P,oult , Ca aci P,o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
� ye
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? V] Yes ❑ No 0 NA ❑ NE
Discharge originated at: ❑ Structure f2�Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes Z[ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ® Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? 1"
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ® Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ® Yes [] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes ® No ❑ NA ❑ NE
i\'
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facility Humber: - / Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
CK Yes
[::]No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
V�[ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9-
Observed Freeboard (in): d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[.Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
❑ No
❑ NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA JEM
® Excessive Ponding U4 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Sane Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): rm
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
foNo
❑ NA
❑ NE
SYes
❑No
DNA
ONE
[Z Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA CKNE
❑ Yes ❑ No ❑ NA EaNE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [—]Yes [—]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes El No
\21. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [—]No
Page 2 of 3
❑ NA ®NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
ja NA ❑ NE
21412015 Continued

Facility Humber: -L3 Date of Inspection: y /
iLZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eff No ❑ NA [SNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [:]No ❑ NA aNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
O Yes
[:]No
❑ NA
[SNE
❑ Yes
[] No
❑ NA
CaNE
❑ Yes
❑ No
❑ NA
�?j NE
❑ Yes 10 No ❑ NA ❑ NE
Co Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes No
❑ Yes ® No
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
74
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Reviewer/inspector Name:
Phone: gIV 3U3 b/ 3 l
Reviewer/Inspector Signature: ,y Date:
Page 3 of 3 21412015

z
Type of Visit: O Compliance Inspection 0 Operation Review Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint ollow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ° Dp Departure Time: �' County: Region:
Farm Name: L It✓>�
Owner Name:��—
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: .(fir—✓` Phone:
Onsite Representative: W rf rfr Integrator: T-
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
_.._`
ign Gnrrent
Design
Current
..
Design C**uNEW
rren4110
t
Swine
Hes,. �'" `''
P
t
WePoult .
Caacity
Wean to Finish
i.
I Layer
�p
Dairy Cow
Wean to Feeder
Non -La er
I
`'"
Dairy Calf
Daia Heifer
Feeder to Finish
Farrow to Wean
D , Fault .
La ers
Design
Ca aci
Current
Poi .
DEy Cow
Non-DairyI�
Beef Stocker
�`!u
Farrow to Feeder
Farrow to Finish
Layers
Beef Feeder
'
Gilts
Pullets
Beef Brood Cow
ry'r
k'4+
Boars
.,. „
Turkeys
Other
P
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C3-No ❑ NA ❑ NE
[—]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 2. No
❑ Yes E C No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Z3 I I I Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [K Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? a Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Spillway?:
Designed Freeboard (in): 4�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CFj No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
® Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA PNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA ;!3-NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No 0 NA 5§-NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] No
❑ NA
[X NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
[] NA
J,NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
A.NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Dg-NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[RNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[ANE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
❑ No
❑ NA
�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
� NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
❑ NA
JaNE
Page 2 of 3
21412015 Continued

Facility Number: - Date Zf —Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes [] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No
the appropriate box(es) below.
Fj Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Fj Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
� y74
w.' 75(AV
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
[] NA aNE
NA [aNE
NA SN E
NA ® NE
[—]Yes D No ❑ NA JE�LNE
Yes [] No DNA ®NE
Yes D No DNA 54NE
Ej Yes No Ej NA 0 NE
Yes D No
Cg Yes D No
Yes [] No
—
PQ NE
D NA
— N Arti
Phone:j�
Date:
21412015

/_
Type of Visit: 0 Compliance Inspection 0 Operation Review (structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint EY Foerllow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:— Arrival Time: a : /,� Departure Time: ,-2 ; County: Region:
Farm Name: C1lYn.
Owner Name: Qs�
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: A yell� ��f�lls----- Title: ©COi't �r
Onsite Representative: %J O p_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
Certification Number:
Certification Number:
Longitude:
Desi rrent Cu
gn •
_
Des n
tg
CurrentE
Design Current
Swine
Capacity Pop ;�,�
Wet Poultry
Capacity
Pop.
���
Cattle - Capacity Pop. ` �
Wean to Finish
Layer
"
DairyCow
Wean to Feeder
Non -La er
-
DairyCalf
Feeder to Finish
h i
DairyHeifer
Farrow to Wean
r.
Design
Current
D Cow
Farrow to Feeder
D ,'.
Poutt .
Ca aci
Po P.
Non -Dairy
Farrow to Finish,
•,
Layers
Beef Stocker
Gilts
Non -La ers
13eef Feeder
Soars
k
Pullets
Beef Brood Cow
N'
Turkeys
Other
Turke Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

[FacHity Number: - 3 % Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? CR Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ; �+
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No'
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P410 ❑ NA ❑1VE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [-]No ❑ NA Ej1'qf_�
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
D-WI{
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑- N
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[2-NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[3-WE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[]-NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
� NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[::]No
❑ NA
E344E-
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[—]No
❑ NA
�
Page 2 of 3
21412015 Continued

Facili Number: jDate of Inspection:__ — /—/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
❑ NA [j--KE
❑ NA [J-9-E
❑ NA C3-RE
❑ NA ❑-NE
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
[:]Yes
❑ No
❑ NA
[a-1'lE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
❑ No
❑ NA
Cj_NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
[�NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
rKE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[21 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
® Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Q Yes
❑ No
❑ NA
❑ NE
Comments (refers tgnes#roa #} Eaplam any YES answers aadlor anytroaal r�ommendatious or any other comment
Use drawings offacil�ty,to;lbetter eplaia srtuatioas{use add�t�onal.'Pages as,neesary)- i
% `_`` L / % �✓yam/ t-Ul�i �� y
�G�.�/4t-off �• ,`�"
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:fD'3s Dl�l
Date:p�-i
21412015

7__G
II
Type of Visit: Q Compliance Inspection 0 Operation Review EMtructure Evaluation Q Technical Assistance
Reason for Visit: O Routine Q Complaint �ollow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: — l — Arrival Time: Departure Time: d ; u County:Region:
Farm Name: L _ �ulYt't. Owner Email:
Owner Name: /x�� (�` ��— Phone:
Mailing Address:
Physical Address:
Facility Contact: kx &- (mod__ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Pop. Wet Pau€ftry
Design
Capacity
Current
Pop.
= Design Gnrrent
Cattle Capacity Pap.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
La er
Non -La er
t
,' Dr 1',onl
Lavers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
�ax}�.uiNu:�?saul>h
©esign Current
Ca gci P.o
•-uXZ-F�mr
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
6
Farrow to Finish
Gilts
Soars
Other
5 her
dli'!M INgdn.n§6uwiwwiY's6glP�ir'.�4ouaniui
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 0 No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
0 Yes ❑ No ❑ NA ❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No [::]NA [:]NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [S-No. ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
S Yes
❑ No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
.Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fallo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(a Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
maintenance or improvement?
I i - Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [mil
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ AppI ication Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
EJ-NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[]!JNlE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Eg-NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[�-I►}�
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[5-#E
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
❑ No
❑ NA
[3-NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:)Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[::]Yes
[:]No
❑ NA
[3-ZLE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[:]No
DNA
[,NE
Page 2 of
21412015 Continued

Facifi Number: c} _ J Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes ❑ No ❑ NA [` - }�E
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA EJ-NE-
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA 0-NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? Ifyes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
y
Reviewer/Inspector Name:
❑ Yes [] No ❑ NA �E
❑ Yes [] No ❑ NA Q--NE
❑ Yes ❑ No ❑ NA [] ?4E
0 Yes ❑ No ❑ NA []-N-E
❑ Yes ❑ No
® Yes ❑ No
0 Yes ❑ No
an,
❑ NA [3--NE
❑NA ❑NE
❑NA ❑NE
Phone:
Reviewer/Inspector Signature:
Paige 3 of 3
Date: k4r f_ z
21412015

Type of Visit: Q Compliance Inspection U Operation Review (6-Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint allow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -- —�� Arrival Time: ,' Departure Time: ,'/ County: /_1__,Region: 'PKb
Farm Name: g u� F�' �a"-'-y - Owner Email:
Owner Name: - wz a� �uJ �� r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: U 0--- Integrator: �fy�
Certified Operator: Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�N Design Current
Design
Current
l3 €
a, Design Current
Swine E=• Capacity Pop
Wet Poultry` a
Capacity
Pop.i•
Cattle
"Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
`u``°
DairyHeifer
Farrow to Wean'`'
r' Design
Current
D Cow
Farrow to Feeder
D , P.oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Cuts
Non -Layers ers
Beef Feeder
NJ Boars
Pullets
Beef Brood Cow
a,
Turkeys
Other
Turke Poults,�ii
Other
Other
��•iill
���.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[HkNo
❑ NA
❑ NE
[:]Yes
❑.No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection- f
—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
® Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Cg No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
®.No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
B-NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
[ENE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
[g-_NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
❑ No
❑ NA
3.�IE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[3,t1E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA [
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑-11;tE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑�lE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA E3-NE
❑ Yes ❑ No ❑ NA [ _NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E3NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA E3-NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA E]-b&
❑ Weather Code
[)Sludge Survey
❑ NA ❑-NE
❑ NA DCIE
Page 2 of 3 21417015 Continued

Facili Number: - Date of IDs ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewedlnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
se drawmgs 1offthtyf oJJns,'{uad,.0al;a"ge..ps
as;necessaryj ,Ii;,> 11
Reviewer/inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
❑ NA ETNE
❑ NA [ -NE
❑ N A P-WE
[DNA B -NE
[:]Yes [:]No ❑ NA [ E
❑ Yes ❑ No ❑ NA [D-NE
❑ Yes ❑ No ❑ NA []-NE
❑ Yes ❑ No ❑ NA ❑-1+1E
❑ Yes ❑ No
(&Yes ❑ No
aYes ❑ No
anc ar anv!nthPr
❑ NA NE
❑ NA ❑ NE
❑NA ❑NE
c©a
Phone:
Date:j�`!�
21412015

I ype or visit: C7 Co dance Inspection U Vperateon Keview U Ntructure Lvaluatzon U Technical Assistance
Reason for Visit: (Routine 0 Complaint follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : 3 0 1 Departure Time: .' p County: Region:
Farm Name: La4o—1 j Owner Email:
Owner Name: a f �[ r a-;C� e-.--- Phone:
Mailing Address:
Physical Address:
Facility Contact: yam-- L O��/yla Title: Q(.ZJP7 r ✓� Phone:
Onsite Representative: Lj— Integrator:���/o��
Certified Operator: ,� �..*-�� _ Certification Number: /E2
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Curre©t
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry.
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
1206,0
--a
Non -Layer I
Dairy Calf
Feeder to Finish
Design
..Current
Dairy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
©. P_oul d
Ca act
P.o
Non -Dairy
Farrow to Finish
ln>
W.
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
N
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 64 No ❑ NA ❑ NE
[] Yes ❑ No
❑Yes No
❑ Yes ❑ No
❑ Yes ®. No
❑ Yes [ o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: LUIate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No [] NA ❑ NE
Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Eq No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. Jj4Yes ❑ No ❑ NA ❑ NE
-Excessive Ponding aHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): .- 7k2_W!N,,AD tj rTsx _j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
U. Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Eg Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
® Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
❑ No
❑ NA
❑ NE
the appropriate box.
59-NVUP QChecklists ®-Design -Maps ease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
5� Yes
❑ No
❑ NA
❑ NE
[54Waste Application -Weekly Freeboard Waste Analysis ®-Soil Analysis
Eg�►+vdas-t-e Transfers
Weather Code
[4j-Rainfall Stocking Crop Yield [� 120 Minute Inspections [Monthly and I" Rainfall Inspections
❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
- ❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ® Yes ❑ No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑Yes Z]No ❑NA ❑NE
fAYes ❑ No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
fZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [N Yes
❑ No
❑ NA
❑ NE
irxiw�ngau�,�ciu�ywucs�erNsa�u'biauaaruns�tusGiuuuuIunnJ psgea;xs^uMCawryl;t
'� /i�Cli"l �-cV` r.j ,.S �T 3�� ; � �� z-.3 ` GQ u� �` 7fiv--�— `]-�',� L� tt� ►jt� �`n-- �— 0 �'7�i � rj�/ j-r Y.
.�i^ r ,'- ��'a'� ,S y"S �r-r�.- d c� �-� /•�e'� r,�o r� �s a�r� i1 h �-�
�// / �jc C r`�✓f i!/'� �`"''o'�i� W ""� �t7c" iL/�1��ye� ��"�' � %� � � �c]"S.S:/�!-,c. {�yC�%z�c�-r�
/S / f+•c (�C/mc�d O. ;.'� v'�' /'�' �,(./ �a l� TO ��U "l.. mil`-ccS �
74 (!f -¢--IVh7 ?7 cz
iUas%Lrf�i2ct/
� / 1
ohol /wy/karrl i~ aGT✓ �L G�Q^� ;1�, Yb(� �•, i v1-C)'*��
at,YJtivjtr
�✓ V ! mar .l > Jam; L j r , �, "r�,� ;,,��, P ©� �,� �� y- LL s7 r,.L
Reviewer/Inspector Name:_�ly�--- _ _ Phone:U—p1(
Reviewer/Inspector Signature:
Page 3 of 3
Date:
��� 21412015
1 `VP w tV' T- �5

hype of Visit: ('Compliance Inspection V Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: Qloutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County:
Farm Name: M t �• rh Owner Email:
Owner Name: �1c.4.Lt; %` f�Ct� r(>'0k4=:
Mailing Address:
Physical Address: J�
Facility Contact: ,11A ctivl. i _t? 6149 fe`�t? Title: Phone:
Onsite Representative:
M
Certified Operator: q
Back-up Operator:
Location of Farm:
Latitude:
Region:
Integrator: f�•-
Certification Number:
Certification Number:
Longitude:
DestgnrCtrrent
Sw3rnnre CAIM
a act Po
kmmiRi.—' a �TA
Design Current
Wet Poult , Ca aci Po
Design Current
Capacity PoF-
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
p
, c' 02
DairyHeifer
Design Current D Cow
D . I OUI Ca aci P,o Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
AM Q �`�a3* *'�`
Other
Other
Turkeys
TurkeyPoults
Other1
.-I=
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E3-Nb ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No En -NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) [:]Yes ❑ No j NA) ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:)Yes ❑^No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - 3 Date of Ins ection: ,
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ _Na—E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? [3 Yes ❑ No ©-NA— ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p�f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Lld4o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑Xo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E] o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C f 5 C---� 5 _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [✓] No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:)Yes �No DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesE�J`No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes ' No
❑ NA ❑ NE
❑ NA D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ErNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
rNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
Ftiz�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
0,No
❑ NA ❑ NE
•25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
;21�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E3"No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ ' o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes [ No ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[2] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below_
❑ Yes
[�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O'1To
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3No
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Fj"No
❑ NA
❑ NE
Ae V
c-e,f( qlc 3D �"- 6us)
Reviewer/Inspector Name
Reviewer/]nspector Signature:
Phone:gl(- -1 D
Date: [ & lk,44' i U
Page 3 of 3 21412015

i ype or visit: e7 tompiiance inspection v vperanon rceview V structure Evamanon u i ecnnicai Assistance
Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Lod Departure Time: ; County: 16 fay
Farm Name_ (,�ic PL�o(A S �[tvC Owner Email:
Owner Name: 0 ,per Ai I &" Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: T tIA f'K� tk"r [ e_t Title: Phone:
Onsite Representative: f Integrator: ) '
Certified Operator: zQjcxvV� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
4_j A ov -
4
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet�Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder D
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oul _
Ca aei
Pto .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
r.
Other
Turkey Poutts
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes D.� ❑ NA ❑ NE
[:]Yes ❑ No []119A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
U NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
[frNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3-No
❑ NA
C] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[3-No
C] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Trea meat
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZL.NQ— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[!T<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑eEvidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S G 0
13. Soil Type(s): E yf _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [TNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes - [D'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
[] Yes [allo ❑ NA ❑ NE
❑ Yes [Jlo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[: No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[, o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[ J.No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E:rNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E30<0 ❑ NA ❑ NE
0.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [j3o No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ems- 'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [ZWo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R'Vo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E3'14o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z 1Mo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EEj<0
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EJ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[E'flo
❑ NA
❑ NE
Comments .{refer to question # ): Explain any YES answers and/or any additional recommendations or any outer conim�entj
Use drawing's of facility to: ibetter.expiain situations (use additional pages as necessary).,.;,,_ _
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 3 _ 3
Date:
2,1412011

'VkvtLk
Structure Evaluation Inspection
Facility Number: et -- �� Date: 2\ - 6( `1 )'
Time in: 1 : &f 4_ Time out: fO c v p
Farm Name: ON A,
kkclV4frr Farm 911 address:
Owner Name: 6 �,� Phone
Facility Contact: f<W C
Onsite Representative: Integrator: Pj,,csl7,.e
Certified Operator: rc,,,wt s - Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No
Was.non-compliant level reported to DWR POA received reis
Structure: 1, 2 3 4 5 - 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): t
Are there any immediate threats to the integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part of the waste management system need repair Yes No •
Condition of field's Oct
Condition of receiving crop lcd,9 ©- vrr5'9e "l
Comments:

0
r
Type of Visit: (2rto Hance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emerizency O Other O Denied Access
Date of Visit: f Arrival Time: Departure Time: % / ; D O County: Region:'
Farm Name: �Aj h t� T L a j N V {,5z-/ y_ Owner Email:
a
Owner Name: ��a/ �i ;� `T+; -�-� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: li*'W .
Certified Operator:
Back-up Operator:
Location of Farm:
cAa4/rwvt Title:
Integrator: 4'-L 10 7
Certification Number:
Latitude:
Phone:
Certification Number:
Longitude:
Design .Current
Design
Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Pouf
Ca aci "`
I'o '.
Non -Dairy
La ers
Farrow to Finish
Beef Stocker
Gilts
Non-i a ers
Beef Feeder
Boars Pullets
Beef Brood Co —
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Number: - / Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4 Structure 5
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
V No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
V[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
O" "'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[6No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [allo [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] EviOdence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)=
13. Soil Type(s):XJf
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F�A No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? mYes R fffo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:)Yes ff-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes allo ❑ NA ONE
❑ Yes 5LNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KA No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CE�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciii Number: - 131 1 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility faii to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes 2-No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes fK No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? 0-Yes o ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or.any additional recommendations or any:other comments
Use drawings of facility to better explain situations (use additional pages as necessary)..
I I
�r _0
I,IJK a5 bar' `- o[c/'n i S l.� D� C c7 / rr•
x 4-j LkJ 4 -t--t- oej s,
d� Lag �T ��� �►��CY�-- i 1 �G �T�� ��mcls
iDOI-
7 ,�
d'3� a-) w��� �ollowu� c��tG�loot
/fp7�;ova 10
i'.S u ydr rJCit) _T
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: GrIltoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: `� �D Departure Time: ; pp County: rw Region: F
Farm Name: 141,4 r +)-- Pla rz, JAJW.In;y Owner Email:
Owner Name: Ix a'7�- Phone:
Mailing Address:
Physical Address:
Facility Contact: rar-'wnr— 67ee- Title: Phone:
Onsite Representative: Integrator: j"�rzs
y^
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
urrent
Z :_ DesiIffic
Wet Poultry` Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er W=�
Non -La er
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
' _- t=`__ `i
Farrow to Wean:
:.= :Design Current
Dry Cow
Farrow to Feeder
. . . . . . . . . . . . . . . . . . . . . ... apinclt P,o ,
on -Dairy
Farrow to Finish
La ers
Non -La ers
Pullets
Beef Stocker
Beef Feeder
Seef Brood Cow
Gilts
Boars
_Turkeys
Other
Turkey Poults
Other
Other
Dischar,aes and Stream ImnaCtS
I. Is any discharge observed from any part of the operation? ❑ Yes � No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: -0 1 IDate_of Inspection:
Waste Collection & Treatment
• 4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
[gNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[::]No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[K No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [K- No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYPe(s)r-rem
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes IZ,,No ❑ NA ❑ NE
❑ Yes C5-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes fZLNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2. No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes K No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: - ZS 171 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Q No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
j4No
❑ NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
rVI No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes J4 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Eq No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IM No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
r_9 No
❑ NA
❑ NE
Cd inents'(refer to question ft Explain any YES'an§veers and/or any additionsl recommendations or any other comments '
Use drawings of facility to better explain situation`s=[use additional pages as necessary}.
g�
%Pi�G � Y� m as � rvdS a�-u ht w kr-r D %`" n cr ci � �� C (� ►rlI cr.�`
Mae k- r 0-z_3-ef'
Reviewer/Inspector Name:
rby F, 7- f� irn ; D FFi �/— feys � W
vL_ Phone: �lp�sf;3 33
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

(Type of Visit: Q Compliance Inspection .0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Routine O Complaint (D"F"ollow-up Q Referral 0 Emergency Q Other O Denied Access
Date of Visit:Arrival Time: S Departure Time: 1 b County:
Farm Name: (� n`I Lldlv" Owner Email:
Owner Name:t.1' "� Phone:
Mailing Address: �f
Physical Address: f
Facility Contact:
Title:
�o
Onsite Representative: t L
Certified Operator: & &_&_f T{ e
I( & Z..e Y yt(
Region: L %
Phone: 1(0-1 o —6ogi
Integrator: �_J`%,✓
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Des i Current gn �
-7Fin
Design Current
Design Current
CapacityoeCapacity'
P..op..attle
__
Capacity Po
TWean
La er
Dai Cow
0 pd
d
on -La er
Dai Calf
Fe
` " - _;..
D ' Heifer
Farrow to Wean
Design Cy rr enit
D Cow
Farrow to Feeder
Non -Dairy
D . ;1?oultr Ca aci = Po' .
La ers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
01
Boars
Pullets
Beef Brood Cow
Turkeys
Other . Turkey Poults
F—To—ther Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Q No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [rNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes eNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

n
FAcili Number: - Date of Ins ection: 4,0
Waste Collection & Treatment
4.' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [LKo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
[5 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Ergo-
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[E es
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[21 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
��
g2 110
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ZAKo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application
Outside of Approved Area
12_ Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Flo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a>e
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E;Pto
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]I No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E2,X'
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G2'1�0
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] YesF�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

ncility Number: G - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA [ZNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field [] Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA [D,16
❑ Yes [:]No ❑ NA D NE
❑ Yes [] No ❑ NA E2,VI:
[:)Yes [:]No ❑ NA [INE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [] No ❑ NA [R'9E
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ZNE
34. Does the facility require a follow-up visit by the same agency? [::]Yes ❑ No ❑ NA F!�NE
Comments ,(refer to question__): Explain any YES answers and/or any additional recommendations or any other comments N _ 7
Use drawings of facility to better explain situations (use. additional pagesaas necessary).
ti-tt gceY
aN� -^ Cp trJ e 11-f
Reviewer/Inspector Name: 1J C,�` i�J PhoneAo - 33N
� r �1
Reviewer/Inspector Signature: Date:$` hs
Page 3 of 3 21412011

Type of Visit: (WCom liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: WRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: `3U County: " r I� Region: p
Farm Name: i� h 1 [- IG�-1T� ACr-•� Owner Email:
Owner Name: r Q r- L Q kkuw% Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: a Phone:
Onsite Representative: 1 e �� orb+ _ Integrator:
Certified Operator: It Certification Number: 110 Z
,/��
Back-up Operator: � y1.4 .'� Certification Number: ffn
Location of Farm: Latitude: Longitude:
gn Current Design Current-
," * ,. Design Current
EWe�P
Capacity Pop. onitry- Capacity Pop. Cattle Capacity N
Finish
La er
Dai Cow
Feeder
O d
S
Non -La er
Dai Calf
Finish
-
Da' Heifer
Wean
Design Current
D Cow
Feeder
E
,
Dr $Pool Ca aei P,o
Non -Dairy
Beef Stocker
Finish La ers
Non -La ers
Beef Feeder
Pullets
Turkeys
Beef Brood Cow
t7ther _ Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes
[—]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes
[�No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 2Nes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued
i

a
Facility Number: Oct- Date of Inspection:
*Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes [] No ❑ NA ❑ NE IL
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): OLj
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [B<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public healtb or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? �es ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [ Yes or
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cdt �t r4 au"4e � 0299,
-
13. Soil Type(s): J!:�' IC(A-VPA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[B'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E?<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ffNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U 'Yo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes LJ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes Fff No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t 20 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ' No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: (h9 - jDate of inspection:
t4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Mllo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes B3 *No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [E"No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E]No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ ' o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
I_J o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
U34o
❑ NA
❑ NE
Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Y s
Q'hio
El NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
VYes
❑ No
❑ NA
❑ NE
Comments (refer to question, #: Explain any YES answers and/or any: additional recommendations or any other comments
_.
Use drawings:of facility to better-eip"Inin situations (use additional }ages as necessary):
IV -?ram 4&*1
O-L l ip "/
J
..40
w�a'tev— -toep 6401, d'` p
1 �/`• c.�•.a.t S C'Jr �"L ✓U CYiL%� t. I�'r-c 6�'
so[td s,Cf s �'
n _n
Zc 3 `i r'o k aW Y (� a ��' u-v [� t�Ac.A
6LY, r RE?
t `
ppC7 !
I 4L L)
Reviewer/Inspector Name: 6
c
Reviewer/Inspector Signature:
Page 3 of 3
Phone: !q17 k3 3-U 3 T
Date: �Aq
21412011

�Ipy -Z;�06x
ivision of Water Quality
Facility Number ®- 131 O Division of Soil and Water Conservationr�-
V Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GlAoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5 = ff Arrival Time:1 /,9:001 Departure Time: + a c7 County:.` Region:
Farm Name: j %Ai`K- j n %.j�,tTS r Y Owner Email:
Owner Name: a`�'IC� s� i L1-t Phone:
Mailing Address:
Physical Address:
Facility Contact: le=jl Title: (g2?&±AV Phone:
Onsite Representative:
Certified Operator: S�
Back-up Operator:
Integrator: r5r!;
10,
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
bapaci
3J,er"N ultry
I 11-ayer
Design
Capacity
I
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
G,a
d D
Non -La er I
Dairy Calf
Feeder to Finish
_
D . P,L
I Layers
Design
Ca aci
0-0-lurren-
Po
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
IPUIlets
Turke s
I Turkey Poults
Other
113eef Feeder
jlieef Brood Cow
Boars
nt
ML
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes Q3-No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE
z. Is there evidence of a past discharge from any part of the operation? [:]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faciti Number: 2 - .3 / jDate of Inspection: 5- /,-�2_
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [, No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Z, No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
Z] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop //Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
[:]Yes
®No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes UR No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [a No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No [] NA ❑ NE
❑ Yes LA No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes 2 No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explainany.YES answers and/or any additional recommendations.or any, othej�comments P
Use drawings of facility to better explain situations (use additional pages 'as. necessary).
Reviewer/Inspector Name:
Phone: 9yo-33- �30�
Reviewer/Inspector Signature: _ Date:
Page 3 of 3 21412011

0
Type of Visit: aC,ommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
C6 I
Reason for Visit: koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: N — Arrival Time: ! OD Departure Time: Q', O County:
Farm Name: (�AI %}� % A. ', .1 S Owner Email:
Owner Name: CaN%r s d f -} Fto n— Phone:
Mailing Address:
Region: LE
Physical Address: /
Facility Contact: r ! rn-jt e_ Title: Phone:
Onsite Representative: S' ��� Integrator: !Eke-5 c�,
Certified Operator: Certification Number: 17 Z O-7--
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�f
:..
Design
Current Design C►urrent
Design C«urrent
Swine
Ca aci
H p
p, ry 4. Capacity Pap. Cattle
Po Wet Poult
at
Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
4,040
er
I
Dairy Calf
Feeder to Finish
y:w:=.
_ Dairy Heifer
Farrow to Wean
D . Poul. ,
Design Current Dry Cow
Ca aci P,o Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
Turkeys
_----_
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2,No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA , ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 5?1-No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

]Facility lumber: - jDate of Inspection: 14{
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
C ] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[&No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
2,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C& No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 lbs. ❑ Total Phosphorus ❑
Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift
❑ Application Outside of Approved Area
/Wind
12. Crop Type(s): f`Cjr4Gru- ���C�Sz5.-,-d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[]Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JE No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. []Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ®,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
[3 NA ❑NE
Page 2 of 3 21412011 Continued

Wacility Number: JDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [NNo
25. Is the facility out of compliance with pennii conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
WNA ❑ NE
❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
No
[DNA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
0 Yes 5�r`No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes allo
❑ Yes 3 No
❑ Yes Ig No
[3 NA ❑NE
❑ NA ❑ NE
❑ NA ❑ N$
Comments (refer to question ft Explain any. YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use. additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone:,-�~'3�
Date: _y '7o
21412011

i
Type of Visit rO Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:�L Arrival Time: §�� J D Departure Time: County: 15 j&2jjF R .+ Region:
Farm Name: W41 ?/at : #1 5 LArs=9' Owner Email:
Owner Name 0 M ` 1. t& rC Phone:
Mailing Address:
Physical Address:
Facility Contact: l s`-�,o!'l e ( Dries Title: j 2,1, 1 �0or g a— Phone No:
dv
Onsite Representative: , _-t— - Integrator:rx's;i�
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o =' = Longitude: = o =' =
Design Current
Design Current
Design Current
Swine Capacity Population
VVet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder I bolk)
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ l a ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance than -made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: a— Date of Inspection
Waste Collection & Treatment
j 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes 5d No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ®,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) ' X A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®..No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
t,No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RLNo
❑ NA ❑ NE
.Comments (refer to question:#). Explain any YES answers and/or any recommendahons or any other comments.
Use drawings of facility to better explain situations. (use additional p ges'ass n essary) w
jf.11f'�`t•: �-fy'`�������/.S'�-� t?a5 �Yrr�
���axC�r� � a N z�l..cJ C��✓c�'a'-� t'`�°rs
�
J 7PI. .
Reviewerlinspector Name
Phone:-qj 0"
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection !
4 Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps - El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IR No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5a No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26_ Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
❑ Yes f4 No ❑ NA ❑ NE
Additzonal:;Co.mments and/ar�Drawin § t1.
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection 0,O,ppeeration Review 'Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint llow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: r! Departure Time: ' County:
PPL,5 Ar��, / "Wnar F.mnil-
Owner Name: raper
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:��
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region:V
Location of Farm: Latitude: = o = ' 0" Longitude: a ° Q ' = u
Design Current
Design Current
IIIDesign
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑Non -La ers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Qther
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�l No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(;,No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

I
Facility Number:LEI Date of Inspection
{ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
91Yes
❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
4&Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Desi6med Freeboard (in): _� 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
� No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
,KYes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
10 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA RNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA El_k
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
❑ No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #) Explain any YESranswers�andlor any.recommendations or any other coanments.
Use drawgin s of facility to better explain srtuat ns (use additional pages as necessa_ry):
- . _ s
s
%D 6i-
Reviewer/Inspector Name `f � Phone: 9%/}-D3`33VO
Reviewer/Inspector Signature: Date:
12,128104 Continued

Facility Number: Cf— Date of Inspection
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 13NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [6NE
the appropriate box. ❑ WUP 0 Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [9 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
®-NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
K[NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
9NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
J&NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
%NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
RNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
9�NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
KNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
q NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
151 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ayes
❑ No
❑ NA
❑ NE
12128/04

K
Type of Visit Q Compliance Inspection O Operation Review Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: /®/ Arrival Time: r3D Departure Time: r �� County: Region:`
Farm Name: li,IA;4e ��il ;,��� '� u r Ste! 7 ��O%�,wnnmail:
Owner Name: LL Z/1%AA1 z r,. LiT[1 rr�/X"'Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: Integrator: �f2'�/�____
01
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = = u Longitude: [----] ° = , ❑ u
Design Current
Design Currene
Res!gn�Gurrent
pulation
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Discharges
&Stream Impacts
1. Is any discharge observed from any part o1'the operation?
El Yes
E[No
❑ NA
❑ NE
Discharge originated at: El structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
®No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
[A No
❑ NA
❑ NE
other than from a discharge?
I2/28/04
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment —do—
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes 115No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2SNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ISM ;?r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 91 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ' fo ❑ NA NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WRo ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
j@ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ENE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
❑ No
❑ NA
CNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Q NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
QNE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
TO X,;wr-- e/�1�
�QJ/7r���di�rp� Gilt ��lfst ;nay—y�� /i1Q�/i �Tu/v� �7�2/1 In ad
Reviewer/Inspector Name >✓Y�� Phone: Wo-/Za ---U"
Reviewer/] nspec to r Signature: Date: g'— 91-
12128104 Continued

M
Facility Number: q Date of Inspeetion
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [ZNE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA P NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[3NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
10 NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
Q NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[Z NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
P NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
51 NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
RrNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
8 NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Grp �,, � %J �uJa� Sr � V.
i!14
12128104

Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time Q f 1 Departure Time: 1 County: Region:
Farm Name: ,,/!�_ !•--a : rt.3 /�Nutr„��1�`i Owner Email:
Owner Name: Cerra" 1, S 1 - l hb—J1 ec &Per 'c6e &C k Phone:
Mailing Address:
Physical Address:
Facility Contact:9AH—_#0.4-Y Title:
Onsite Representative:
Certified Operator: ftLs�,r�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [:] o ❑ ❑ Longitude: ❑ ° ❑ ❑
' ADesigrr
Current
r ` Desrgn` Current
i �.
Design Current
wit. all lei
Population
Wet Poultry Capacity `Population
Cattle
Capacity Population
Wean to Finish
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
R No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
[allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
DiNo
❑ NA
❑ NE
other than from a discharge?
11/28/04
Continued

I
Facility Number: — 3 f Date of Inspection LSQZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
® Yes
@FNVo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[9No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): }
Observed Freeboard (in): T �—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
R No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C5No ❑ NA
❑ NE
8. Do any of the stuctures tack adequate markers as required by the permit?
❑ Yes
g No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
ryes
f/
fNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ja No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes NrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) ;Ynclno, 2Y�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
Cl Yes [21No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
29 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
9 No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�r�7k AL
roy'w%- "-3 dDrcc 07"(/3 6 0(
�, Farm wQ.� a�����-rr`� ��- dv�,�- v�s;� �i°��-�..2 %i>•�s �� �� _
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection S a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f4 No ❑ NA ❑ NE
the appropiate box. ❑ yup [[ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW W?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
t. No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
q--No
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes 9No ❑ NA ❑ NE
❑ Yes C.No ❑ NA ❑ NE
❑ Yes Y�& No ❑ NA ❑ E
❑ Yes kNo ❑ NA ❑ENE
❑ Yes [a No 0 NA ❑ NE
[( Yes W ❑ NA 0 NE
Additional Comments and/or Drawings:
Ti c/` %S Ga.F s . 1�,carl�� D rrae�h►crc� (�cJ;�[ Cz-v_te A�ecd
>od� �j IYi krP w 5
33- F'o f )avu� � L !-
-1� I I'm q 'fr;h � l-
fir'►K b��\ Surv� �riF�^in�v�-��� �-b�
12128104

IType of Visit Q�fompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Cher ❑ Denied Access
Date of Visit: Arrival Time: icy Departure Time: r County: Region:
Farm Name:
Owner Name
Mailing Address:
Physical Address:
Facility Contact:Title:
nail:
Phone No:
Onsite Representative: it�,,,,P _ Integrator:
Certified Operator:-_ B r f ��rG�� /G Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o = 1 ❑ fl Longitude: = o = t = 6i
";ffIl'e_iig.
n Current Design ECurrent Design Current
Swine apacity ll?opulationWet Poultry Capecty Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dai Cow
Wean to Feeder 0 C7 Non -La ei ❑Dai Calf
❑Feeder to Finish "( n''l gr x ❑ Dai Heifej
El Farrow to Wean x ❑
Dry Poultr} ,� Dru
Cow
,5 LL �_-�3 a _•.
El Farrow to Feeder � Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Co
r [] Turkeys
Other : - ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JN No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,� No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection a
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes ❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
10 Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ff
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are,there structures on -site which are not properly addressed and/or managed
❑ Yes H No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes 9No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes fK No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes CANo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA J4 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA RNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
CKNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
J2`NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
18. is there a lack of properly operating waste application equipment?
❑ Yes
§ No
❑ NA
L
Comments (rferetoques oa'#} Exotain any YES answe�rs�and/or any recommendations or'any other comments.
qd N arpa�
g ..p ( °p l;es as necessary}
Use draH rn s of factli to better ex lain situations use ddittoa
I-elobw lyl Rrdati f r u si u�vl4 1V
t^itnF.- A_ O, A'lWPA&Y-9IA; [ IV%51 is
r `°v 16 a- 6_4 6 T19A
� r
Reviewer/ins ector Name - Phone a
p . �/��133 3�
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: — c3 Date of Inspection g
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EM No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 09 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes m No ❑ NA X.NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[8 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ENE
Other Issues
-
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[) Yes
gNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
;9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
,Yes
❑ No
❑ NA
❑ NE
6-�,-U
7.
7se rem zm4
r19A
u,
wit( 1� p
12q&04

9
e
E /3 )
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [IDenied Access
Date of Visit: Arrival Time: ! iq , i7 Departure Time: r O a County: Z ef,­ Region: ZO
Farm Name:
Owner Name:
Mailing Address:
mail:
Physical Address:
Facility Contact: CA r'tct—ne GrV1-G Title: Phone No:
Onsite Representative: _ ,4AWC Integrator:
Certified Operator: ^�� ar e eOperator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = t1 Longitude: = = ❑
46
111111111111111111111111111M Design
Current
Design Current
Design Current
ne Capacity
Population
�i'et Poultry
Capacity Population
C•attic Capacity Population
Wean to Finish
:E1
❑ Layer
❑ DairyCow
Wean to Feeder
Q D
❑ Non -Laver
❑ Dai Calf
❑ DairyHeifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
aBoars
❑ Pullets
❑ Beet Brood Cowl I
❑ turkeys
Other -_
❑ Turkev Puults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
El No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Z No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

f
Facility Number: Date of Inspection od
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): L _�
Observed Freeboard (in): 42 O
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes D§ No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Mycs ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2.No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ELNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12, Crop type(s)-&- .�LY/hI.Cj - —
---
13. Soil type(s) J�-: X 74
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
Ej No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
fZ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E.No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
C-No
❑ NA ❑ NE
Comments (refer to question #) Ezplatn any YES answers and/or any recommendatibns ory other comments"`
Use drawings of fain cility to better explasituations. (use additional pages as necessary) k
, _.xw�€.: _-
r�6n%Ptue (�(lprk;�y Bn o�� JiCS U t�`� r5 1N�dc JL
U l/
n`fcr--6QI-.Jvr7 Syr �`�� ��' •
L33
Reviewerllnspector Name ��- ' ��-�� Phone:/D/-7-7.4
Reviewer/[nspector Signature: Date: y2z/-(7(��
Page 2 of 3 12128104 Continued

f
Facility Number: — Date of Inspection
i
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9KNo ❑ NA ❑ NE
the appropriate box- ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91-No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[5No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EgNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[4No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J&No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency'?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings
4u
of 3 12128104

O Division of Water Quality
Facility Number 09 3 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit )gCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ErFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 08 01
Arrival Time: Q' S Departure Time: � ;$�}}� County:
Farm Name: i +1 '' i` UIJ Ph Owner Email:
flwnar NamP• C�IlArlpf �'4-� 14nh + H r7ard-pi) Phana-
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
,�� Onsite Representative: Cae- r,2 � 6P 63�3 Integrator: Pteifa4 P
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = e = A 0is Longitude: = ° 0 g 0
is
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
r IYQ ❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current,
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c_ What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection )�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?.
Designed Freeboard (in): q
Observed Freeboard (in):C+I011LSOD
— v-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA �R NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? IR Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 91 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA 9 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA RNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area ,
12. Crop type(s)
13. Soil type(s) - x
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA RNE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA
N NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
❑ No
❑ NA
JR NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
[9 NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA
® NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Seu"I�rf_ar ))ad_ d (rt add-e4 a.,o wire Seede4 , G-lazs�ia C a.,dC l ooks�aad,
Sa��i`t'rnQIAijgb-y
cre- Coaef Ureas ivi`fh 0.ri -Pet, rwne. yNgli h1`Mv]c�fGco/),9ngy
.1
G r fp , i)lesse_ keep work, a�,-�le,� �r yak;vyqbcc ec��i-
Leo 1✓ o � t
Reviewer/Inspector Name , Phone: TO q33-33—?3
Reviewer/inspector Signature S Date:
12128104 Continued

Facility Number: Q q — 13 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ENE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ®NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA CRNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
CR NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[3 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�TNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑-No
❑ NA
9NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo
❑ NA
4WNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
R NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
&No
❑ NA `WNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&jNo
❑ NA
-BtNE
Additional Comments and/or Drawings:
12128104

Division of Water Quality S
Facility Number f O Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:.!_ T D
Farm Name: Y*a<<� �_(�I6er;e , _ Owner Email:
Owner Name: Cna rkc5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: r G l Integrator: f're-,Z —•
Certified Operator: J!a✓tt.C_ �1%1(z`ff a�orr�� Operator Certification Number: 14?,9262� _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] o [:]' = Longitude: = ° =' = "
Swine
Wean to Finish
.Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
i2taQ I ?Zmd ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design`""
Cattle Capacity P
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heife3
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes f.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
P& No
❑ NA
❑ NE
❑ Yes
P.No
❑ NA
❑ NE
12128104 Continued

l
. % Facility Number: Date of Inspection l�C"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
[KNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
.Yes
❑ No ❑ NA Cl NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
jffl No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
§4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
04-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) j�j "pt #.eV / Ve
13.
Soil type(s) 017__�AA
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®.No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
9[Yes
❑ No
❑ NA
❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes
FI-No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Jallo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
6D'L n v-zf W v
Reviewer/Inspector Name �� Phone:
Reviewer/Inspector Signature: Date:
o12/28/04 Continued

- Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropirate box. ❑ W­Up ❑ Checklists
❑ Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
%No
❑ NA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fait to have an actively certified operator in charge?
❑ Yes
IgNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
IKNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
19 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
gLyes
❑ No
❑ NA
❑ NE
Additional Comments and/or
pev-,� we5"'lr 4120�1 P�5 eCr'P71'-_3 ,, P, ci4� /VV
�0e, CAC)
� �Crntud���jn�"
12128104

i
Type of Visit (ErCornpliance Inspection 0 Operation Review 0 Structure Evacuation 0 Technical Assistance
Reason for Visit online O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: 4 Arrival Time:: ' 0 Departure Time: ; Qfl County: LR - PL Region: fR
Farm Name: w �' `�— 9:"Z a-. n �_ Owner Email:
Owner Name: a drL �_S _ ' i Z -fv ✓t Phone:
Mailing Address:
Physical Address: nn Facility Contact: [fQd'A'`e C /�
—Z),f"-r-- Title: Phone No:
Onsite Representative: �Selcrn .• Integrator:
Certified Operator: �ir%Q/�r Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o ❑' ❑" Longitude: =° =. ❑ u
CD161
F
Swine
Capaty Population
Wet Poultry
Capacityopulation
Cattle Capacity Population
❑ Dai Cow
❑ airyCalf
❑ Feeder to FinishT
Wr
Dai Heifer
❑ Farrow to Wean
Dry Poultry
W,.
"
❑ D Cow
❑ Farrow to Feeder
-ry __
❑ Non -Dairy
❑ Farrow to Finish
❑ La era
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
- _
-
❑Turke s
Other
❑ Other
� :t"s
❑Turke Poults
❑ Other
Number of Structures:
❑ Wean to Finish
❑ La er
Wean to Feeder
OL.O
❑Non -La er
Discharges &Stream Impacts
1.
Is any discharge observed from any part of the operation?
El Yes
ZLNO
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
❑Yes
®No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
[R No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑Yes
®No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
[9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
0,No
❑ NA
❑ NE
other than from a discharge?
Page ! of 3
12/28/04
Continued

Facility Number: — 3 1
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
®.No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
k4No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
STO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No ❑ NA ❑ NE
mai ntenancelimprovement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Eallo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Croptype(s) l5>dlrnuda /->G�v /err
- l
13. Soil type(s) 'LC5 x 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
"® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[XYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
C& No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
1 � ..�:., -': r«lc�•x��l'fc � .F.. �
Comments (re&rr'ta question ft Explain any YES'aa,swers and/or any recommendations or any othericag5m�sments
Use drawings of facility to better. explain situation's: (use additional pages as necessary)c` b T
AL
lye, ) t 1,4
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: /2!:
Page 2 of 3 12128104 Continued

s
Facility Number: Date of Inspection o -_3�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes jO No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [:3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o ❑ NA ❑ NE
NL Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
E.No
❑ NA
❑ NE
❑ Yes
CO No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
(A No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
(4 No
❑ NA
❑ NE
❑Yes 19No ❑NA [I NE
[:]Yes JO No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes RNo - ❑ NA ❑ NE
❑ Yes
PdNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings: `t
a) . wr yT) (4 /` lv ea) GQ l:
Page 3 of 3 12128104

T
Type of Visit QPC—ornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: '! 1�] Departure Time: O; c7� County: �� �'"� Region:
N
Farm Name: �� �LQ%�3 &r��, Owner Email:
Owner Name: Phone:
C'kh'Q
Mailing Address:
Physical Address: �� J
Facility Contact: _�L,`r'�'�l s!' Title: Phone No:
Onsite Representative: G� �� I- L.�t>>AA`//r Integrator:
Certified Operator: _ /f e+p'r_'c — Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ t = Longitude: = ° = I 0 u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
10 Wean to Finish �{
10 Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder !
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Laver
Dry Poultry
❑ Lavers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ urkey Poutts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
UJ No
❑ NA
❑ NE
❑ Yes
5d No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
W No
❑ Yes
(M No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 2- lcS j
Date of Inspection�/z-zf�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[d No
❑ NA ❑ NE
a. If yes,. is waste level into the structural freeboard?
❑ Yes
W-No
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
P No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
❑ Yes
5j No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
54 Yes
❑ No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yeS
� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) CZ5,,r
13. Soil type(s) A5 X !4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
& No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination![]
Yes
[A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Qd No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V1 No
❑ NA
❑ NE
dditional:p
cJrrtY O I ,S' aG� u�.� �l � �rec a�+*- L� e0 •"--�3v.��f
t Tod ✓»�L
If Reviewer/inspector Namefw r Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Y —
I:aeffity Number: — / Date of Inspection — 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropiate box.
❑ WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 5a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JO No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R1 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
54NA
LINE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
($ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�] No
❑ NA
El NE
Additional Comments and/ar."sDra}wings
12128104

Type of Visit • Compliance Inspection Q Operation Review O Lagoon Evaluation
(Reason for Visit O Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 9 Date of Visit: 1 29 Time: 1__iJ_�
- - O Not Operational O Below Threshold
U Permitted 13 Cerdfied 13 ConditionallyCertified0 Registered
Farm Name: WL-60
Owner Name: QdA
Mailing address: �O _,f litl Csf,..,rs,n
Facility Contact: —cux,� /Ui . {'i 0. eroi-, Title:
Onsite Representative:�� ~ �►`sf Ise oQ_�
Certified Operator:
Location of Farm:
Date Last Operated or Above Threshold:
County: 9 61 tek&
Phone No: 9!D - t0 !„E - IAd .3 2 3
....7 n1 cW .. Z8 33
Phone No: M
integrator. pt +mot a__
Operator Certification Number.
swine ❑ Poultry 0 Cattle ❑ Horse Latitude • ' 0" Longitude �• �< �"
Discharges & Strum Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ELNo
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes V .No
Identifier:
Freeboard (inches):
12112103
Struet�� 1 Structure 2
H2
Structure 3 Structure 4 Structure 5 Structure 6
Conibued

Fac�it3 Number: - r 31 Date of Inspection !G
r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes ,K No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes IK No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes &No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation marldngs?
Waste Application
10. Are there any buffers that need maintenanoe/improvement? ❑ Yes SNo
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes RNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
A.:. Crop type Co0.s�nL&r •--t u t(OL — La V
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JKNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R No
b) Does the facility need a wettable acre determination? ❑ Yes O�rNo
c) This facility is pended for a wettable acre determination? ❑ Yes Sa'No
15. Does the receiving crop need improvement? ❑ Yes R,No
I6. Is there a lack of adequate waste application equipment? ❑ Yes M No
Odor Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JqNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes PLNo
Air Quality representative immediately.
Final Notes
+s. `rl',-Y & -*-
4o
���- -
L .. s t f w; . by
ReviewerAW spector Name
Reviewer/Inspector Signature:
r�i»mz
Date: /e /y9 /v
rAmtk"Ad

Facility Number: — f f Date of Inspection fo 29 0
r
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes $Q No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes RNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes SkNo
❑ Waste Apphc.-Zot'❑ Freeboasl/ ❑ Waste AnalyV/❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes & No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 1KNo
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes K&No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes O(No
28. Does facility require a follow-up visit by same agency? ❑ Yes JkNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes 5'No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit7(If no, skip questions 31-35) ❑ Yes VNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35_ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ RainfaiKO Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Nursab w. 01 - 31
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:
faneral Info sue. a
Farm Name: WkAc- Plg;,us
ow=Name: C 4rl�s D_ NCI o�+ _ �honeNo• r9�a)g�z-83
On Site Representative: lntegraior: �rr�stR Fa,•�. s
- ..� � .�
Mailing Address•—_,_ P O
c/;:Sabc!•1,+,,," N C ZS337 _
Physical Address9=ation:_ __-E2 xV�—i 6 -LbzrJ - bav, li(uvs<A-c,
Lon •lode:
Qneration Dj§cription: (based on design charactetisda)
Type of Swine No. of Animals . Type of Poulay No. of AnImak 75N of Cattle No. of Animals
3'IthWWy & O !p O 0 Noo-amw O Beef
0 o da
Other a of Livestock NumbergLAnmal!:
Nbmber Of Lagoons: i (include in the Drawings and Observations the f veboatd of each lagoon)
Facility In ,_ 'On:
Lagoon •
Z
Is lagoon(s) freeboard less than lfoot + 25 year 24 boar storm storage?: 3.5 IF-1
Yes i]
No 0(
Is seepage observed from the lagoain?:
Yes 0
No E10'
Is erosion obserndt
Yes 0
- No m
Is any discharge observed?
Yes ❑
No M-'
❑ Man -mods I1 Not Man-made
Cover Crop '
Does the facility need more acreage for spraying?:
Yes O
No ar
Does the cover crop need improves cat
Yes O
No u'
(an the crops which need bVrVMaaWW)
Crop sc1u A=W-,
No
Is a dwelling located within 200 feet of waste application? _
Yes 0
--No
- Is a well located within 100 feet of waste applicatim? - : - _
Yes 0
M;I..
No
Is animal waste stockpiled within I0O feet of USGS BIue Line Stream?
Yes O
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stre m?
Yes a
No

maintenance /
Does the facility maintenance need improvement? Yes 0 No M
Is there evidence of past discharge from any part of the operation? Yes 0 No C '
Does record keeping need improvement? Yes 0 No it
Did the facility fail to have a copy of the Animal Waste Management Plan on site? .Yes O No M-"
Ce-r-f . N000 874,
Explain any Yes answers•
Signattme:,�
c= Facility Auesmm Unk Use Attachments ¢Needed
Prgwings or Observations:
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AOI — lanuat717JM